A Typical MRI Features of Wernicke’s Encephalopathy: A Case Report
DOI:
https://doi.org/10.24079/cajms.2024.04.004Abstract
Objective: This case report highlights the rare occurrence of Wernicke encephalopathy (WE) in a non-alcoholic patient with atypical imaging findings. Methods: Diagnosis is made based on clinical and imaging findings. Results: A 44-year-old man with a history of inability to walk, ataxia, and did not have a habit of alcoholism. Magnetic resonance imaging (MRI) showed symmetrical bilateral basal ganglia changes. Conclusion: We should always be included in the differential diagnosis for bilateral basal ganglia lesions. MRI has proven useful in diagnosing WE in patients with occasional neurological symptoms and atypical imaging findings.
Downloads
20
References
1. Zuccoli G, Pipitone N. Neuroimaging Findings in Acute Wernicke’s Encephalopathy: Review of the Literature. AJR Am J Roentgenol. 2009;192:501-508. https://doi.org/10.2214/ajr.07.3959
2. Manzo G, De Gennaro A, Cozzolino A, et al. MR imaging findings in alcoholic and nonalcoholic acute Wernicke’s encephalopathy: a review. Biomed Res Int. 2014;2014:503596. https://doi.org/10.1155/2014/503596
3. Harper C, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry. 1986;49(4):341-345. https://doi.org/10.1136/jnnp.49.4.341
4. Antunez E, Estruch R, Cardenal C, et al. Usefulness of CT and MR imaging in diagnosing acute Wernicke’s encephalopathy. AJR Am J Roentgenol.1998;171:1131-1137. https://doi.org/10.2214/ajr.171.4.9763009
5. Galvin R, Bråthen G, Ivashynka A, et al. EFNS guidelines for diagnosis, therapy, and prevention of Wernicke encephalopathy. Eur J Neurol. 2010;17:1408-1418. https://doi.org/10.1111/j.1468-1331.2010.03153.x
6. Zuccoli G, Siddiqui N, Bailey A, et al. Neuroimaging findings in pediatric Wernicke encephalopathy: a review. Neuroradiol. 2010;52(6):523-529. https://doi.org/10.1007/s00234-009-0604-x
7. Zuccoli G, Cravo I, Bailey A, et al. Basal Ganglia involvement in Wernicke encephalopathy: report of 2 cases. AJNR Am J Neuroradiol. 2011;32(7):E129-E131. https://doi.org/10.3174/ajnr.a2185
8. Ashikaga R, Araki Y, Ono Y, et al. FLAIR appearance of Wernicke encephalopathy. Radiat Med. 1997;15(4):251-253.
9. Hegde A, Mohan S, Lath N, et al. Differential diagnosis for bilateral basal ganglia and thalamus abnormalities. Radiographics. 2011;31(1):530. https://doi.org/10.1148/rg.311105041
10. Arendt, C.T., Uckermark, C., Kovacheva, L. et al. Wernicke Encephalopathy: Typical and Atypical Findings in Alcoholics
and Non-Alcoholics and Correlation with Clinical Symptoms. Clin Neuroradiol 2024;34:881–897. https://doi.org/10.1007/s00062-024-01434-y
11. Lapergue B, Klein I, Olivot JM, et al. Diffusion weighted imaging of cerebellar lesions in Wernicke’s encephalopathy. J Neuroradiol. 2006;33(2):126–128. https://doi.org/10.1016/s0150-9861(06)77243-1
12. Martin PR, Singleton CK, Hiller-Sturmhofel S. The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health. 2003;27(2):134–142.
13. Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s Encephalopathy and Korsakoff’s Psychosis. Alcohol Alcohol. 2006;41(2):151–158. https://doi.org/10.1093/alcalc/agh249
14. Magistretti PJ, Allaman I. A cellular perspective on brain energy metabolism and functional imaging. Neuron 2015;86:883-901. https://doi.org/10.1016/j.neuron.2015.03.035
15. Ota Y, Capizzano AA, Moritani T, Naganawa S, Kurokawa R, Srinivasan A. Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol 2020;38:809-820. https://doi.org/10.1007/s11604-020-00989-3
16. Le Bihan D, Poupon C, Amadon A, Lethimonnier F. Artifacts and pitfalls in diffusion MRI. J Magn Reson Imaging.2006;24(3):478–488. https://doi.org/10.1002/jmri.20683
17. Maeda M, Tsuchida C, Handa Y, et al. Fluid attenuated inversion recovery (FLAIR) imaging in acute Wernicke encephalopathy.
Radiat Med. 1995;13(6):311–313.
18. Alfadhel M, Almuntashri M, Jadah RH, Bashiri FA, et al. Biotinresponsive basal ganglia disease should be renamed biotinthiamine
responsive basal ganglia disease: a retrospective review of the clinical, radiological and molecular findings of 18 new cases. Orphanet J Rare Dis. 2013;8:83. https://doi.org/10.1186/1750-1172-8-83
19. Donnino MW, Carney E, Cocchi MN, Barbash I, et al. Thiamine deficiency in critically ill patients with sepsis. J Crit Care. 2010;25(4):576–581. https://doi.org/10.1016/j.jcrc.2010.03.003
20. Fei GQ, Zhong C, Jin L, Wang J, et al. Clinical characteristics and MR imaging features of nonalcoholic wernicke encephalopathy.
AJNR Am J Neuroradiol. 2008;29(1):164–169.
21. Weidauer S, Nichtweiss M, Lanfermann H, Zanella FE. Wernicke encephalopathy: MR findings and clinical presentation. Eur Radiol. 2003;13(5):1001–1009. https://doi.org/10.1007/s00330-002-1624-7
22. Murata T, Fujito T, Kimura H, Omori M, et al. Serial MRI and (1)H-MRS of Wernicke’s encephalopathy: report of a case with remarkable cerebellar lesions on MRI. Psychiatry Res. 2001;108(1):49–55. https://doi.org/10.1016/s0925-4927(01)00304-3
23. Mascalchi M, Simonelli P, Tessa C, Giangaspero F, Petruzzi P, Bosincu L, et al. Do acute lesions of Wernicke’s encephalopathy show contrast enhancement? Report of three cases and review of the literature. Neuroradiology. 1999; 41(4): 249–54. https://doi.org/10.1007/s002340050741
24. Hegde AN, Mohan S, Lath N, Lim CC. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011; 31(1): 5-30. https://doi.org/10.1148/rg.311105041
25. Brami-Zylberberg F, Méary E, Oppenheim C, et al. Abnormalities of the basal ganglia and thalami in adults. J Radiol 2005; 86:281–293. https://doi.org/10.1016/s0221-0363(05)81357-5
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Mongolian National University of Medical Sciences

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.